ProviderMatters

Medical Policy Update (April 2025)

Posted on April 7, 2025

Please read the following update related to various Health New England programs and changes that may have an impact on your patients and/or your practice.

If you have any questions about the information in this notice, please contact Health New England Provider Experience at (800) 842-4464, extension 5000. A representative is available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.

Updates Notes
Medical Policies Transcatheter Pulmonary Valve Implantation (TPVI)

  • Effective June 1, 2025
  • New Policy

 
  Insertion of Implantable Wireless Pulmonary Artery Pressure Sensor and Monitoring (i.e., CardioMEMS)

  • Effective June 1, 2025
  • Annual review with following changes:
    • Updated CMS coverage
    • Title updated with addition of “Implantable”
    • Added to Criteria I: Individual is on maximally tolerated GDMT or has a documented intolerance to GDMT (e.g., hemodynamic instability)
    • References updated
  • No coding changes

 
  Neurostimulators

  • Effective June 1, 2025
  • The criteria for Deep Brain and Cortical Stimulation, as well as Gastric Electrical Stimulation, have been incorporated into the policy rather than being outlined in a separate document.

 
  Bariatric Surgery

  • Effective June 1, 2025  
  • Updated commercial line of business to follow Interqual criteria
  • Updated references

 
  Lymphedema – Surgical Treatment

  • Effective June 1, 2025
  • Minor Criteria Changes
  • References updated
  • Codes 15830-15877 added (procedure addressed in existing policy)

 

 

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Categories: Provider Newsletter

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